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Mitral Insufficiency

The mitral valve is one of the four natural valves in the human heart. It has the very important task of helping blood return to the heart from the lungs. It is made of two parts (called “leaflets”) which open when the heart relaxes, and close when the heart squeezes. It separates two chambers of the heart, referred to as the “left atrium” and “left ventricle”.

The mitral valve is supposed to function as a one-way valve. Between each heart beat, blood should come back from the lungs into the left atrium and ventricle. The mitral valve keeps the blood from flowing back into the lung as the heart squeezes with each heart beat.

The most common problem with the mitral valve is insufficiency , also called “regurgitation.” In this condition, the heart's mitral valve does not close properly, causing blood to leak (back-flow) into the left atrium (upper heart chamber) when the left ventricle (lower heart chamber) contracts. This results in blood to flowing backwards from the heart into the lungs rather than forward from the heart into the rest of the body. This can result from a congenital (genetic) problem, a tear in the structure of the valve, an infection, or as a result of weakened heart muscle.

Symptoms

Most often, patients feel that they have worsening shortness of breath. Typically these changes will occur over a few months, but may develop more quickly. Some patients may not have typical symptoms and the mitral valve disorder is diagnosed when their doctor hears a heart murmur. A murmur is an abnormal sound produced by a leaking or tightened heart valve. other symptoms may include:

Chest pain, unrelated to coronary artery disease or a heart attack

Cough

Palpitations

Rapid breathing

Diagnosis

A disorder with the mitral valve is commonly confirmed with an echocardiogram, which is an ultrasound scan of the heart. This test allows us to see the heart valves as well as the direction of blood (both normal and abnormal) going through the heart.

Treatment

Mitral valve regurgitation can usually be treated with medications alone, such as diuretics (“fluid pills”) and medications to lower your blood pressure. Infections can often be treated with antibiotics. We grade the amount of leakage based on measurements taken during the echocardiogram as either mild, medium, or severe. If the amount of leakage is mild or medium, this can usually be managed with medications. If the amount of leakage is severe, if the heart chambers are starting to enlarge, if the heart muscle is getting weaker, or if you have developed an abnormal heart rhythm then we usually recommend surgery.